HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -�WA �- b
Permit Number: Day
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_-- -- -- Building Permit Appii ation APR 3 0 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: rRo'�k
PROPOSED IMPROVEMENT LOCATION:
Address: T400 S. Ot cAu, 14v . -� %04-L3 -V�V't,- Q LOLCi," Tn- 341 5�
Property Tax ID #: ��pot Lot No.
Site Plan Name: OCJ�1 n '`O We YS Block No.
Project Name:
11
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters. —Windows/Doors
X Electric X Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3'1 Sao . 00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:"""'
Name W
Name: Y.A,�V1 %V �/u -'t SYh
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Address: qAW DGCA* I Y •
Company: JV6 Omw-'r �2�'s { Joiy5,�Y1
City: wce" Q xal State: b
Address: \o�� iU.
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State):
Zip Code:_'=FaX +;—
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Zip Code -- a- L&, 00Phore
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E-Mail ,nai
Fill iri fee simple Title Holder�on rid)&page (if different
E-Mail A-W% f'S. 6A-n
State or CouhYy L'icense'""' (:6L \�O b3o
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name: \1`I
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLD€R: )Q Not Applicable
Name:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: �`f✓
Address:
City: State:
Zip: Phone:
BONDING COMTNY: w Not Applicable
Name: l� 1'
Address:
Zip: Pho
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO ID
COUNTY
OF ltit�P.ti
The f rgoing instr menty✓ s acknowledged before me
this liiiay of� 204-by
k)97; -er'JUV&-DO.NSv N
Name of person making statement.
Personally Known ' OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pffic- State of
Commission No. tee:^+ At•:'RE�;3IQIMPHREy
t > ? M1 COMMISSION# GG 300817
REVIEWS
COUNTER I REVIEW I REVIEW
STATE OF FLORIDA -
COUNTY OF 4e4B i
The forgoing instru nt was acknowledged before me
this day of 20A by
74'4?T wog7doi Ate �U J�S®r hl-
Name of person making statement.
Personally Known � OR Produced Identification
Type of Identification Produced
���- .
(Signature of No Public- State of Florida )
Commission No.�AUDREYB.HUM 'HREYHREY
pq YS WCOMMISSIONSGG300817
,`.. EXPIRES: Mardi 6, 2023
REVIEW I VREVI WON S REVIEW MANGROVE